Getting a prescription

Any general practitioner, family physician, or nurse practitioner with some basic training can assess for and prescribe hormone therapy to adults, although many may not have received training. Counsellors, psychologists and psychiatrists may also perform hormone readiness assessments and write letters of recommendation to clinicians who are able to prescribe.

Not all primary care providers are comfortable initiating hormone therapy and may require a letter from a mental health professional or other clinician with experience doing readiness assessments before writing you a prescription. Some primary care providers may prefer to refer to an endocrinologist or other clinician rather than being the prescribing clinician. We hope that as more primary care provides receive basic hormone therapy education, this will occur less frequently.

Counselling is not typically required to get a prescription for hormones although it can be very helpful for some people. It may be required or recommended if:

you are uncertain about whether hormone therapy is the right decision

you are not out to significant others and do not have a plan in place to come out, or

you have significant mental health or substance use concerns

The assessment

Assesment period

The length of the assessment period depends on the health care provider, clinic protocols and your needs. A few visits to your health care provider, over the course of 2 to 6 months, is usually needed before hormone therapy is started.

Assessment may take longer if someone has medical, mental health or substance use issues. These concerns are not necessarily barriers to hormone therapy, but should be reasonably well controlled before starting. Another factor is age: assessors may wish to have several meetings with a youth before making a recommendation for hormones.

Physical exam

Your health care provider will usually perform an exam. They will also likely ask you to do some laboratory work, such as a blood test.

Questions you'll be asked

During the assessment, you will be asked about:

your gender identity and feelings about your body

your goals. Some people wish to feminize or masculinize their body, while others wish to appear more androgynous. This may impact your medication dosage

the effects you expect to see from feminizing or masculinizing medications

your understanding of the long-term risks associated with hormone therapy

your support network and strategies for thriving in your changing gender expression with family and friends, at work and at school

If you are a youth

If you are a younger youth seeking puberty blockers or hormone therapy, you will typically receive a hormone readiness assessment with a qualified mental health professional, such as a psychiatrist or psychologist. Then you will be referred to a pediatric endocrinologist who prescribes and monitors the treatment. In some cases a primary care provider such as a pediatrician may be involved in your assessment and treatment.

For youth, when you visit your mental health professional to talk about starting puberty blockers or hormones, they will likely want to discuss:

how you understand your gender identity

the way you express your gender identity

how you feel about your body

how you are doing emotionally

your relationships with peers and family

your experiences at school and in the community

what to expect from puberty blockers and hormone treatments

what puberty blockers and hormone treatments won’t do

For recommendations of mental health professionals who work with trans youth, contact Trans Care BC.

Eligibility & criteria

You do not have be trans to be eligible for hormone therapy. Hormone therapy can be medically necessary for a range of people, including those who are non-binary, genderqueer, or gender diverse.

capacity to make a fully informed decision and to consent to treatment

being of the age of majority (in BC, the age of majority is 18).

significant medical or mental health concerns, if present, must be reasonably well-controlled

For children and youth under the age of 18, the criteria for hormone therapy are:

a long-lasting and intense pattern of gender non-conformity or gender dysphoria

gender dysphoria emerged or worsened with the onset of puberty

any coexisting psychological, medical, or social problems are stable enough to start treatment

the adolescent having given informed consent. The consent of your guardian is preferred, but not absolutely necessary under the BC Infants Act

In some cases, health care providers may prescribe hormones even when these four criteria are not met. For example, a health care provider may prescribe hormones as an alternative to illicit or unsupervised hormone use. Also, the presence of mental health concerns (such as depression or anxiety) or addiction does not necessarily mean you do not meet the criteria. Instead, these concerns will need to be reasonably managed prior to, or during, hormone therapy.